Authors: Wim Laleman Annelies Verreth Baki Topal Raymond Aerts Mina Komuta Tania Roskams Schalk Van der Merwe David Cassiman Frederik Nevens Chris Verslype Werner Van Steenbergen
Publish Date: 2013/05/25
Volume: 27, Issue: 10, Pages: 3865-3876
Abstract
Endoscopic ampullectomy is established as a valuable treatment for adenomas of the Vaterian papilla Few large series are available however let alone any with longterm followup Moreover multiple tangible issues remain The aim of our study was to evaluate efficacy safety and outcome of endoscopic ampullectomy and compare it to existing literatureThis is a singlecenter retrospective study with a minimal followup of 3 years including 91 patients including familial adenomatous polyposis FAP and nonFAP who had an endoscopic ampullectomy between 2000 and 2008 Outcome parameters included ampulloma characteristics biotical accuracy as well as safety efficacy recurrence rate and survival after endoscopic ampullectomyEndoscopic resection was successful in 71 patients 78 Histological review of the resected specimens revealed nonspecific changes 138 low or medium grade dysplasia 529 high grade dysplasia 218 and carcinoma 183 Bioptic accuracy was 383 Overall complications were observed in 23 patients 252 pancreatitis 154 hemorrhage 121 and cholangitis 49 Recurrence occurred in 183 Fourteen patients underwent pancreaticoduodenectomy Survival after complete endoscopic ampullectomy was excellent for patients with low to moderate grade dysplasia and high grade dysplasia Incomplete endoscopic resection of high grade dysplasia or invasive carcinoma was associated with unfavorable outcome when treated merely endoscopicallyEndoscopic ampullectomy is obligatory for assessment of the true histological nature of an ampulloma Endoscopic resection is a safe and efficient procedure for adenomas with low to moderate dysplasia but also for high grade dysplastic lesions provided that a complete endoscopic resection is achieved
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